McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 5 1 Diuretic agents

Farrell, M. & Dempsey, J. (2014). Smeltzer & Bare’s Textbook of Medical-Surgical Nursing (3rd edn). Sydney: Lippincott Williams & Wilkins. Goodman, L. S., Brunton, L. L., Chabner, B. & Knollmann, B. C. (2011). Goodman and Gilman’s Pharmacological Basis of Therapeutics (12th edn). New York: McGraw-Hill. Harvey, S. & Jordan, S. (2010). Diuretic therapy: Implications for nursing practice. Nursing Standard, 24(43) , 40–49. Hurst, J. W., Fuster, V., Walsh, R. A. & Harrington, R. A. (Eds.). (2011). Hurst’s the Heart (13th edn). New York: McGraw-Hill. Khatib, R. (2011). Prescribing diuretics in the management of heart failure. Nurse Prescribing, 9(9) , 435, 437–441. McKenna, L. (2012). Pharmacology Made Incredibly Easy (1st Australian and New Zealand edn). Sydney: Lippincott Williams & Wilkins. McKenna, L. & Mirkov, S. (2014). McKenna’s Drug Handbook for Nursing and Midwifery (7th edn). Sydney: Lippincott Williams & Wilkins. Porth, C. M. (2011). Essentials of Pathophysiology: Concepts of Altered Health States (3rd edn). Philadelphia: Lippincott Williams & Wilkins. Porth, C. M. (2009). Pathophysiology: Concepts of Altered Health States (8th edn). Philadelphia: Lippincott Williams & Wilkins. Roberts, M. E. & Epstein, B. J. (2009). Optimizing management of hypertension with combination therapy: Considerations for the nurse practitioner. Journal of Cardiovascular Nursing, 24(5) , 380–389. Shannon, G. (2011). Severe hyponatraemia—recognition and management. Australian Prescriber, 34(2) , 42–45. Sumnall, R. (2007). Fluid management and diuretic therapy in acute renal failure. Nursing in Critical Care, 12(1) , 27–33. Watson, C. & Annus, C. (2013). Intravenous diuretic delivery in the home. Nursing Times, 109(14) , 20–21. a. they block the sodium pump in the loop of Henle. b. they cause loss of sodium and chloride but little water. c. they do not cause a fluid rebound when they work in the kidneys. d. they have little or no effect on electrolyte levels. 4. The nurse or midwife would anticipate an order for a loop diuretic as the drug of choice for a person with: a. hypertension. b. shock. c. pulmonary oedema. d. fluid retention of pregnancy. 5. When providing care to a person who is receiving a loop diuretic, the nurse would determine the need to regularly monitor which of the following? a. sodium levels b. bone marrow function c. calcium levels d. potassium levels 3. Thiazide diuretics are considered mild diuretics because:

WEB LINKS

Healthcare providers and students may want to consult the following Internet sources: www.heartfoundation.org.au Information on HF, pathophysiology, treatment and research. www.heartfoundation.org.nz Information on HF, pathophysiology, treatment and research. www.medsafe.govt.nz New Zealand Medicines and Medical Devices Safety Authority. http://nzformulary.org New Zealand Formulary.

BIBLIOGRAPHY

Bennett, S. (2008). Diuretics: Use, actions and prescribing rationale. Nurse Prescribing, 6(2) , 72–77. Berry, S. D., Mittleman, M. A., Zhang, Y., Solomon, D. H., Lipsitz, L. A., Mostofsky, E., Goldense, D. & Kiel, D. P. (2012). New loop diuretic prescriptions may be an acute risk factor for falls in the nursing home. Pharmacoepidemiology & Drug Safety, 21(5) , 560–563.

C H E C K Y O U R U N D E R S T A N D I N G

Answers to the questions in this chapter can be found in Appendix A at the back of this book.

MULTIPLE CHOICE Select the best answer to the following. 1. Most diuretics act in the body to cause:

a. loss of calcium. b. loss of sodium.

c. retention of potassium. d. retention of chloride. 2. Diuretics cause a loss of fluid volume in the body. The drop in volume activates compensatory mechanisms to restore the volume, including: a. suppression of ADH release and stimulation of the countercurrent mechanism. b. suppression of aldosterone release and increased ADH release. c. activation of the renin–angiotensin–aldosterone system with increased ADH and aldosterone. d. stimulation of the countercurrent mechanism with reflex drop in renin release.